Irazuzta Jose, Sullivan Kevin J
Division of Pediatric Critical Care Medicine, University of Florida Health Science Center at Jacksonville and The Wolfson Children's Hospital, 800 Prudential Drive, Jacksonville, FL 32207, USA.
Neurol Res Int. 2010;2010:497326. doi: 10.1155/2010/497326. Epub 2010 Aug 19.
Objective. The optimal management of pediatric patients with arterial ischemic stroke (AIS) is not known. Despite this, goal-oriented, time-sensitive therapies geared to rapid reestablishment of arterial blood flow are occasionally applied with beneficial effects. The inconsistent approach to AIS is in part due to a lack of knowledge and preparedness. Methods. Case report of a 12-year-old male with right middle cerebral artery (MCA) occlusion resulting in dense left hemiplegia and mutism and review of the literature. Intervention(s). Mechanical thrombectomy, intra-arterial administration of rt-PA, vasodilators, and platelet inhibitors, and systemic anticoagulation and subsequent critical care support. Results. Restoration of right MCA blood flow and complete resolution of neurologic deficits. Conclusion. We report the gratifying outcome of treatment of a case of AIS in a pediatric patient treated with hyperacute therapies geared to arterial recanalization and subsequent neurologic critical care and review the pertinent literature. Guidelines for the emergency room management of pediatric AIS from prospective, randomized trials are needed.
目的。小儿动脉缺血性卒中（AIS）的最佳治疗方案尚不清楚。尽管如此，旨在迅速重建动脉血流的目标导向型、对时间敏感的治疗方法偶尔应用时会产生有益效果。对AIS治疗方法不一致，部分原因是缺乏相关知识和准备。方法。报告一名12岁男性因右侧大脑中动脉（MCA）闭塞导致左侧偏瘫和缄默症的病例，并对文献进行综述。干预措施。机械取栓、动脉内注射rt-PA、血管扩张剂、血小板抑制剂、全身抗凝以及随后的重症监护支持。结果。右侧MCA血流恢复，神经功能缺损完全消失。结论。我们报告了一名小儿AIS患者接受旨在动脉再通及随后神经重症监护的超急性治疗后取得的令人满意的治疗结果，并对相关文献进行了综述。需要来自前瞻性随机试验的小儿AIS急诊室管理指南。
